MEDICARE IGNORES PHARMACY CALLS TO SPEED REIMBURSEMENT

Medicare officials are turning
a deaf ear to pleas from
pharmacy and congressional
leaders to speed up payments
to community pharmacists
participating in the new Part D
prescription drug plan.

At least 41 House Republicans
have been urging
the agency to put an end to
the cash-flow problems afflicting
many independent pharmacies.
Pharmacists at these
stores blame pharmacy benefit
managers for failing to
pay them in a timely manner.

In a written appeal to the
Centers for Medicare & Medicaid
Services (CMS), the 41
GOP lawmakers asked the
agency to require plans to
pay pharmacies within 14
days of a prescription's being
filled. They also called for
new requirements offering
pharmacists electronic payments
for Part D prescriptions
dispensed.

CMS officials, however, are
resisting pressure to intercede
on behalf of pharmacists.
They contend that the
initial problems associated
with the new drug program
have been overcome and that
most pharmacists are receiving
Part D reimbursement
promptly.

According to the CMS officials,
the majority of claims
from pharmacists are paid
within the 14-day time frame
envisioned by the House legislation,
and 18 of the 20 largest
Part D plans pay all claims
within 30 days of receipt. CMS
officials also have stated that,
"outside of Medicare, payment
within 30 days is largely
the industry standard?the
payment time lines in
Medicare are comparable
to or better than those
that exist elsewhere in the
health insurance industry."